Chronic Lymphocytic Leukemia (CLL): Bendamustine is used for the treatment of patients with chronic lymphocytic leukemia. Its effectiveness compared with first-line treatments other than Chlorambucil has not been clearly established.

Non-Hodgkin Lymphoma (NHL): Bendamustine is indicated for patients with indolent B-cell non-Hodgkin lymphoma that has progressed during treatment with Rituximab or within six months after completing a rituximab-containing regimen.

Multiple Myeloma: Bendamustine is also indicated for the treatment of patients with multiple myeloma.

Bendamustine is a bifunctional mechlorethamine derivative that produces electrophilic alkyl groups capable of forming covalent bonds with cellular components. Through its action as an alkylating agent, it creates both intra-strand and inter-strand crosslinks within DNA. These crosslinks interfere with DNA replication and transcription, ultimately leading to cell death. Bendamustine is active against both rapidly dividing and resting cancer cells, although the precise mechanism responsible for its cytotoxic effects has not been fully clarified.

Chronic lymphocytic leukaemia: 100 mg/m infused over 30-60 min on days 1 and 2 of a 28-day cycle for up to 6 cycles. For severe haematological or non-haematological toxicity: Reduce dose to 50 mg/m on days 1 and 2 of each cycle. If severe haematological toxicity recurs, further reduce dose to 25 mg/m on days 1 and 2 of each cycle. May consider dose re-escalation in subsequent cycles.

Multiple myeloma: 120-150 mg/m infused over 30-60 min on days 1 and 2 of a 28-day cycle. IV or oral prednisone may be given at a dose of 60 mg/m on days 1-4 of the cycle.

Non-Hodgkin's lymphoma: 120 mg/m infused over 30-60 min on days 1 and 2 of a 21-day cycle for up to 8 cycles. For severe haematological or non-haematological toxicity: Reduced to 90 mg/m on days 1 and 2 of each cycle. If severe toxicity recurs, further reduce dose to 60 mg/m on days 1 and 2 of each cycle.

Bendamustine plasma levels may increase when used with CYP1A2 inhibitors such as ciprofloxacin or fluvoxamine. Conversely, plasma levels may decrease when used with CYP1A2 inducers, including omeprazole and tobacco smoking.

Bendamustine is contraindicated in patients with a history of hypersensitivity reactions such as anaphylaxis, patients with jaundice, severe bone marrow suppression, significantly low leukocyte or platelet counts, severe hepatic impairment, or those who have undergone major surgery within the previous 30 days.

Common adverse effects include fever, nausea, vomiting, cough, headache, fatigue, diarrhea, constipation, loss of appetite, weight loss, skin rash, stomatitis, lymphopenia, anemia, thrombocytopenia, leukopenia, and neutropenia.

Bendamustine is classified as Pregnancy Category D. There is positive evidence of fetal risk; however, the drug may be used in life-threatening conditions or serious diseases when safer alternatives are ineffective or unavailable.

Caution should be exercised in patients with mild to moderate hepatic or renal impairment. The drug should also be used carefully during pregnancy and lactation.

Moderate hepatic impairment may require approximately 30% dose reduction.

Symptoms of overdose may include cardiotoxicity and thrombocytopenia.

Management may involve supportive measures such as bone marrow transplantation and blood transfusion to control hematological complications. Bendamustine is only minimally removed by dialysis.

Cytotoxic Chemotherapy

Store below 25°C before reconstitution and protect from light.